A Special Message From Our Encounter Data Team About Data Submission

Hello SCAN Provider Partners,

The January CMS Encounter Data Sweep is approaching. We are 5 weeks away from SCAN’s Target Date! This is the FINAL CMS sweep impacting 2016 DOS (2017 payment) and requires the submission of encounters for DOS range 01/01/2016 à 12/31/2016. CMS currently plans a 75% RAPS and Fee for Service and 25% EDS and Fee for Service blended risk score based on 2016 DOS.

SCAN has two dates for you to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, December 29, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, January 26, 2018

o   After this deadline, SCAN will NOT process any files received for the January CMS sweep

7 STEPS YOU CAN TAKE TO PREPARE:

1. Review your SCAN monthly Encounter Submission Reports
1. November reports were uploaded to the SCAN Encounter Data Portal on 11/01/2017. The next ESRs will be uploaded the first week of December 2017.

2.       Review your SCAN Encounter HCC Reconciliation Reports

1. This report is available to you monthly. If you would like to utilize this report for the January Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

b.      Reports with dates specific to the January CMS sweep dates 01/01/2016 à 12/31/2016 will be uploaded before end of week 11/13/17.

  

3. Review your SCAN All DX Reconciliation reports
1. This report is available to you monthly. If you would like to utilize this report for the January Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?

§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 01/01/2016 à 12/31/2016.

2. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

4. Review your SCAN PCN Reconciliation reports
1. This report is available to you monthly. If you would like to utilize this report for the January Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.

§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?

§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 01/01/2016 à 12/31/2016. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately

2. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of January 31, 2018.

Additional Steps:

5. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

6. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
2. Send these files sooner than later; please do not to wait until December 29, 2017 to upload your files.
3. ICE files should only be used to submit additional DX codes or deletes of DX codes.

§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

7. Follow up on additional cleanup requests (contact your respective HCI representative with your direct questions)
1. Provider Name Mismatch (PNM) rejection reports
2. Rendering Provider/Entity (RPX) rejection reports
3. EDS Full Encounter Data rejection reports
4. Invalid DX rejection reports
5. ICE File Pend reports

What are the Timelines?

1. Submit all 01/01/2016 à 12/31/2016 DOS encounters to your Clearinghouse: 12/29/2017
2. Last day for ICE file submissions of additions/deletions of DX codes for 01/01/2016 à 12/31/2016 to SCAN: 12/29/2017
3. CMS Sweep deadline for SCAN: 01/31/2018

* Remember: SCAN has two dates for provider partners to manage towards:

Ø  SCAN Target Date for Provider Partners: EOB Friday, December 29, 2017

o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, January 26, 2018

o   After this deadline, SCAN will NOT process any files received for the January CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!

  

If you have any questions or concerns, please feel free to contact me directly or reach out to SCAN’s HCI Representative:

o   Michelle Nguyen: MNguyen3@scanhealthplan.com

Best regards,

Christina Cabiltes

Supervisor, HCI Projects

AHRQ and HealthIT.Gov Post EMR Information

The Agency for Healthcare Research and Quality (AHRQ) has posted an Electronic Health Record (EHR)  primer for physicians and hospitals.  This primer provides guidance for providers in the use of EMRs.  The AHRQ’s mission:

The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

The AHRQ primer references the Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by HealthIT.gov, the official site for Health IT Information.  Because certified EHRs are part of CMS’ quality programs in FFS Medicare, the guides were developed to aid providers in the implementation and use of them.   

The SAFER guides provide  an additional resource for providers seeking information on EHRs.  The following SAFER guides are available:

·         High Priority Practice

·         Contingency Planning

·         System Interfaces

·         Computerized Provider Order Entry with Decision Support

·         Clinician Communication

·         Organizational Responsibilities

·         System Configuration

·         Patient Identification

·         Test Results Reporting and Follow Up

Finally, AHRQ has developed free CME (1 CME unit for American Board of Internal Medicine) and Medical Knowledge/Patient Safety credit (up to 45 MOC points).   There is a related CME program, The Hazards of Distraction: Ticking All the EHR Boxes available on the AHRQ site (registration required).

We hope this information is helpful.